From curses to poisons to diseases, there are a number of afflictions that can affect a creature. While each of these afflictions has a different effect, they all function using the same basic system. All afflictions grant a saving throw when they are contracted. If successful, the creature does not suffer from the affliction and does not need to make any further rolls. If the saving throw is a failure, the creature falls victim to the affliction and must deal with its effects.

Afflictions require a creature to make a saving throw after a period of time to avoid taking certain penalties. With most afflictions, if a number of saving throws are made consecutively, the affliction is removed and no further saves are necessary. Some afflictions, usually supernatural ones, cannot be cured through saving throws alone and require the aid of powerful magic to remove. Each affliction is presented as a short block of information to help you better adjudicate its results.

Name: This is the name of the affliction.

Type: This is the type of the affliction, such as curse, disease, or poison. It might also include the means by which it is contracted, such as contact, ingestion, inhalation, injury, spell, or trap.

Save: This gives the type of save necessary to avoid contracting the affliction, as well as the DC of that save. Unless otherwise noted, this is also the save to avoid the affliction's effects once it is contracted, as well as the DC of any caster level checks needed to end the affliction through magic, such as remove curse or neutralize poison.

Onset: Some afflictions have a variable amount of time before they set in. Creatures that come in contact with an affliction with an onset time must make a saving throw immediately. Success means that the affliction is avoided and no further saving throws must be made. Failure means that the creature has contracted the affliction and must begin making additional saves after the onset period has elapsed. The affliction's effect does not occur until after the onset period has elapsed and then only if further saving throws are failed.

Frequency: This is how often the periodic saving throw must be attempted after the affliction has been contracted (after the onset time, if the affliction has any). While some afflictions last until they are cured, others end prematurely, even if the character is not cured through other means. If an affliction ends after a set amount of time, it will be noted in the frequency. For example, a disease with a frequency of “1/day” lasts until cured, but a poison with a frequency of “1/round for 6 rounds” ends after 6 rounds have passed.

Afflictions without a frequency occur only once, immediately upon contraction (or after the onset time if one is listed).

Effect: This is the effect that the character suffers each time if he fails his saving throw against the affliction. Most afflictions cause ability damage or hit point damage. These effects are cumulative, but they can be cured normally. Other afflictions cause the creature to take penalties or other effects. These effects are sometimes cumulative, with the rest only affecting the creature if it failed its most recent save. Some afflictions have different effects after the first save is failed. These afflictions have an initial effect, which occurs when the first save is failed, and a secondary effect, when additional saves are failed, as noted in the text. Hit point and ability score damage caused by an affliction cannot be healed naturally while the affliction persists.

Cure: This tells you how the affliction is cured. Commonly, this is a number of saving throws that must be made consecutively. Even if the affliction has a limited frequency, it might be cured prematurely if enough saving throws are made. Hit point damage and ability score damage is not removed when an affliction is cured. Such damage must be healed normally. Afflictions without a cure entry can only be cured through powerful spells, such as neutralize poison and remove curse. No matter how many saving throws are made, these afflictions continue to affect the target.

He failed a DC 15 Fortitude save to avoid contracting it, so after the onset period of 1d3 days has passed, he must make another DC 15 Fortitude save to avoid taking 1d6 points of Strength damage. From this point onward, he must make a DC 15 Fortitude save each day (according to the disease's frequency) to avoid further Strength damage. If, on two consecutive days, he makes his Fortitude saves, he is cured of the disease and any damage it caused begins to heal as normal.

Diseases and Poisons Optional Rules

The standard rules for diseases and poisons don't necessarily mimic the progression of these afflictions in a believable way; a character with a few lesser restoration spells can simply ignore most diseases, and diseases and poisons that don't affect your Constitution score can never kill you. What's more, because these afflictions tend to affect ability scores, their effects can be unrealistically powerful—a poison that damages Intelligence can take down any creature of animal intelligence, regardless of CR. The following optional system presents progression tracks for diseases and poisons that cause the victim's situation to become increasingly worse.

Progression and End States

When a victim fails his initial save and is afflicted with a disease or poison, he immediately gains the effects of the first step down that affliction's progression track. For diseases, this is latent/carrier; for poisons, it's usually weakened.

This replaces the affliction's normal effects (such as ability damage and ability drain), though many afflictions still produce additional symptoms. At the GM's discretion, truly deadly diseases and poisons might cause the victim to start further along the progression track than normal.

All effects from disease and poison tracks are cumulative.

Most afflictions also have an end state—a point at which the disease or poison has progressed as far as it can. Once an affliction has reached its end state, the victim keeps all current effects (but doesn't suffer further effects) and can no longer attempt saving throws to recover from the affliction. By default, each disease and poison track has an end state of dead, but some afflictions have less severe end states, and others might progress only to a certain intermediate state at worst, allowing victims to continue attempting saves.

In general, whenever a victim fails a saving throw against her affliction, she moves one step further down the progression track, gaining the effects of the next state and keeping all previous effects, until she reaches the end state. If she's afflicted with a disease, she moves one step back toward healthy whenever she fulfills the conditions in the disease's Cure entry (usually by succeeding at one or more saves). Once she reaches healthy, she is cured. Poisons work differently—fulfilling the cure condition removes a poison from the victim's system, but she remains at the same step on the track and recovers gradually. (Treat a poison that has exhausted its duration in the same way.) For every day of bed rest (or 2 nights of normal rest), a victim recovers one step; this recovery is doubled as normal by Heal checks, and tenacious poisons might require a longer recovery period. Usually, neutralize poison or remove disease immediately moves the victim to a healthy state on the respective track, and a heal spell will work for both. However, once the disease or poison has reached its end state, only a more powerful spell such as miracle or wish can remove its effects.

Some diseases and poisons cause the same effects as a condition (such as sickened) or render characters paralyzed. Effects that modify or remove those conditions (such as immunities) do not apply; only effects and immunities that help against diseases or poisons apply, as appropriate.

Diseases

The disease track simulates the progression of a disease, starting with incubation. Ignore any onset entry for a disease; the victim attempts saving throws at a rate based on the disease's frequency. At the GM's discretion, if the disease's cure entry does not allow a cure, the disease's progression may be irreversible without the use of a heal spell, and even a successful remove disease only prevents further deterioration.

There are two different tracks: one for diseases that affect physical ability scores (such as bubonic plague or slimy doom), and one for those that affect mental ability scores (such as cackle fever or mindfire).

Mental Disease Track

Latent/Carrier: A character in the latent stage has the disease, and may pass it on if contagious, but suffers no ill effects.

Weakened: A character weakened by a mental disease suffers all the effects of the shaken condition. The DCs of her spells and spell-like abilities decrease by 2. If she is a spellcaster, she can no longer cast her highest level of spells.

Impaired: A character impaired by a mental disease no longer adds her mental ability score modifiers to the number of uses per day of pools (such as an arcane pool or a ki pool), abilities (such as channel and lay on hands), and bonus spells per day. Her DCs decrease by an additional 2. If she is a spellcaster, she can no longer cast her 2 highest levels of spells.

Befuddled: A character befuddled by a mental disease is losing her grasp on thought, reality, and self. She has a 50% chance each round to take no relevant action, instead babbling randomly, wandering off, or talking to unseen things.

Deranged: A character rendered deranged by a mental disease is almost entirely disconnected from reality. Her mind filters and twists all external stimuli into strange forms.

Comatose: A character rendered comatose by a mental disease has lost all grip on reality and entered an inner world of dreams. She can't be woken by any means as long as she remains in this state on the disease track.

Dead: The disease has harmed the character's brain beyond repair, killing her. The corpse may still be contagious, and some diseases may have unusual effects after the character dies.

Poisons

The poison track simulates the progressive effects of poison in the body. A character who is poisoned rolls a saving throw after the listed onset at the listed frequency. On an initial exposure to poison, regardless of whether her save succeeds, a victim takes an amount of poison damage equal to the poison's DC – 10, divided by 2 (for example, 5 points of poison damage for a DC 20 poison). This is hit point damage, not ability damage. If a victim is exposed to additional doses of the same poison, a failed save progresses the poison track by one step and increases the duration by 50%, but doesn't increase the DC.

Strength Poison Track

Healthy—Weakened—Impaired—Staggered—Immobile—Dead

Weakened: A character weakened by Strengthpoison suffers a –2 penalty on Strength-based attack rolls, damage rolls, skill checks, and ability checks. Her carrying capacity is divided by 3. She is always considered to be carrying at least a medium load.

Impaired: A character impaired by Strengthpoison experiences rapid muscle atrophy. She takes an additional –2 penalty on the affected Strength-based rolls, and is always considered to be carrying at least a heavy load.

Dead: The character's immune system is ravaged by the poison, and she expires.

Intelligence Poison Track

Healthy—Weakened—Impaired—Animalistic—Comatose—Dead

Weakened: A character whose reason is weakened by Intelligencepoison takes a –2 penalty on all Intelligence-based skill checks and ability checks. A character with spellcasting based on Intelligence decreases his DCs by 2 and can no longer cast his highest level of spells.

Impaired: A character impaired by Intelligencepoison does not add his Intelligence bonus to the number of uses per day of pools and abilities (such as an arcane pool) and does not gain bonus spells per day from his Intelligence. He takes an additional –2 penalty on the above Intelligence-based rolls. An Intelligence-based caster reduces his DCs by an additional 2, and he can no longer cast his 2 highest levels of spells.

Comatose: A character rendered comatose by Intelligencepoison is no longer able to process thoughts. He cannot be woken by any means as long as he remains in this state.

Dead: The character's brain stops functioning, and he dies.

Wisdom Poison Track

Healthy—Weakened—Impaired—Confused—Comatose—Dead

Weakened: A character whose awareness is weakened by Wisdompoison takes a –2 penalty on all Wisdom-based skill checks and ability checks, as well as on Will saves. A character with spellcasting based on Wisdom decreases her DCs by 2 and can no longer cast her highest level of spells.

Impaired: A character impaired by Wisdompoison does not add her Wisdom bonus to the number of uses per day of pools and abilities (such as a ki pool) and does not gain bonus spells per day from her Wisdom. She takes an additional –2 penalty on the above Wisdom-based rolls. A Wisdom-based caster reduces her DCs by an additional 2, and can no longer cast her 2 highest levels of spells.

Confused: A character who's confused by Wisdompoison has difficulty processing reality and is dangerous to herself and others. Each round, she rolls on the chart from the confusion spell to determine her actions.

Comatose: A character rendered comatose by Wisdompoison is no longer able to experience reality or receive sensory information. She can't be woken by any means as long as she remains in this state.

Dead: Forever lost in her own inner reality, the character's brain stops working, and she dies.

Charisma Poison Track

Healthy—Weakened—Impaired—Pliable—Catatonic—Dead

Weakened: A character whose sense of self is weakened by Charismapoison takes a –2 penalty on all Charisma-based skill checks and ability checks. A character with spellcasting based on Charisma decreases his DCs by 2 and can no longer cast his highest level of spells.

Impaired: A character impaired by Charismapoison doesn't add his Charisma bonus to the number of uses per day of pools and abilities (such as lay on hands) and doesn't gain bonus spells per day from his Charisma. He takes an additional –2 penalty on the above Charisma-based rolls. A Charisma-based caster reduces his DCs by an additional 2, and can no longer cast his 2 highest levels of spells.

Pliable: A character rendered pliable by Charismapoison has little sense of self and will go along with nearly anything. Bluff, Diplomacy, and Intimidate checks automatically succeed against a pliable character, except Diplomacy checks to improve a pliable character's attitude, which have the normal DC. This still does not allow characters to whom the pliable character is unfriendly or hostile to make requests of the pliable character using Diplomacy.

Catatonic: A character rendered catatonic by Charismapoison can see, hear, and process his environment, but has lost all agency and can't interact with the world in any way.

Dead: The character loses even autonomic functions, and dies.

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Sample Diseases

Examples of diseases that use the various tracks are given below. If a disease does not specify an effect, it imposes only the effects for the victim's state on the pertinent track.